Outcomes In Infertile Patients Research Articles

O-126 Endometrial microbiota composition is associated with reproductive outcome in infertile patients

Abstract Study question Is there an association between the composition of the endometrial microbiota and the reproductive outcomes in infertile patients undergoing in vitro fertilization (IVF)? Summary answer The composition of the endometrial microbiota (EM) prior to embryo transfer is associated with the different reproductive outcomes: live birth, no pregnancy or clinical miscarriage. What is known already The investigation of bacterial communities in the female reproductive tract using molecular methods has revealed the existence of a continuum microbiota that extends from the vagina to the upper genital tract. Previous evidence suggests the existence of an association between the vaginal and endometrial microbiome composition with reproductive and obstetrical outcomes. Specifically, the presence of specific pathogens together with low abundance of Lactobacilli has been associated with poor IVF outcomes. Study design, size, duration Multicentre prospective observational clinical study analysing the EM of infertile patients undergoing IVF (with maternal age ≤40) or ovum donation (≤50 years). A total of 452 infertile patients undergoing IVF/ovum donation were assessed for eligibility in 13 reproductive clinics in Europe, America, and Asia. The duration of the study was 30 months and the recruitment period extended between August 2017 and February 2019 (ct.gov 03330444). Participants/materials, setting, methods Endometrial fluid and endometrial biopsy were collected during a hormonal replacement therapy cycle after 5 days of progesterone (P) administration prior to a frozen embryo transfer cycle. Endometrial microbiota (EM) composition was analyzed using 16S rRNA gene sequencing using compositional data to transform scale-invariant values in both sample types. The EM in fluid and biopsy was associated with live birth, biochemical pregnancy, clinical miscarriage, or no pregnancy. Main results and the role of chance Of the 452 patients assessed, 44 did not meet the selection criteria and were excluded for the study and 66 patients were lost to follow-up. Of the 342 remaining patients, 198 (57.9%) became pregnant [141 (41.2%) had a live birth, 27 (7.9%) had a biochemical pregnancy, 2 (0.6%) had an ectopic pregnancy, and 28 (8.2%) a clinical miscarriage], while 144 (42.1%) did not become pregnant. The baseline characteristics, clinical and embryological variables were homogeneous and no bias toward the clinical outcome categories was observed. Our association study showed that the composition of the EM was associated with the reproductive outcome in both endometrial fluid and biopsy. A dysbiotic endometrial microbiota profile composed of Atopobium, Bifidobacterium, Chryseobacterium, Gardnerella, Haemophilus, Klebsiella, Neisseria, Staphylococcus and Streptococcus was significantly associated with unsuccessful outcomes, especially no pregnancy and clinical miscarriage. In contrast, Lactobacillus was consistently enriched in patients with live birth outcomes. The EM in endometrial fluid did not fully reflect that in endometrial biopsy, although their association with clinical outcome was consistent. Limitations, reasons for caution The main limitation was the small number of biochemical pregnancy and clinical miscarriage analysed. During transcervical collection of endometrial samples caution was taken to avoid contamination with the cervix although cervical contamination cannot be fully discarded. Wider implications of the findings Our data indicate that EM dysbiosis is associated with poor clinical outcome in ART. Thus, the EM composition before embryo transfer could be a useful biomarker to consider offering an opportunity to further improve diagnosis and treatment strategies. Trial registration number Clinical trials.gov 03330444

P–519 Investigation of embryo chromosomal constitution and live birth rate after vitrified-warmed euploid single blastocyst transfer across ranges of maternal body-mass-index

Abstract Study question Does maternal body-mass-index (BMI) associate with blastocysts’ chromosomal constitution and clinical outcomes in infertile patients undergoing preimplantation genetic testing for aneuploidies (PGT-A)? Summary answer A higher euploidy rate per biopsied blastocyst was reported among underweight women. Overweight women were instead subject to higher miscarriage (MR) and lower live-birth-rates (LBR). What is known already Different studies in the literature revealed an association between BMI and infertility, suggesting a J-shaped relationship: both underweight and overweight women can suffer from infertility issues. Even if IVF might increase the success rate in both these categories of patients, it seems insufficient per se to overcome the complex and multifactorial fertility impairment derived from unbalanced nutritional intakes. Miscarriage, in particular, is common in both underweight and overweight women. However, most of the literature is based on chromosomally-untested embryos. Study design, size, duration: Retrospective observational study. Only the first IVF cycle with ≥1 biopsied blastocyst from each woman was included. The primary outcome was the association between maternal BMI (underweight, BMI<18.5, n = 160; normal-weight, BMI=18–25, N = 1392; overweight, BMI>25, N = 259) and the mean euploidy rate per cohort of biopsied blastocysts (m-ER). The secondary outcomes were the association between maternal BMI with clinical (mainly MR and LBR), gestational and perinatal outcomes after first vitrified-warmed single euploid blastocyst transfers. Participants/materials, setting, methods We included 1811 women undergoing PGT-A at a private IVF center between April–2013 and March–2020. The secondary outcomes were investigated on 1125 first vitrified-warmed single euploid blastocyst transfers from all patients obtaining ≥1 transferable blastocyst. Only ICSI with ejaculated sperm and continuous culture in standard incubators were performed. Logistic regressions were conducted to identify putative confounders and adjust the results accordingly. Main results and the role of chance Except for a lower maternal age among underweight women (38.3±3.1 versus 38.9±3.4 yr, p < 0.01) and higher among overweight ones (39.3±3.6 yr, p = 0.04), no difference was reported with respect to normal-weight women in terms of duration of infertility, hormonal levels, main cause of infertility, sperm quality, and reproductive history. The mean number of biopsied blastocysts was ∼3 in all groups. The m-ER shows a decreasing trend as the maternal BMI increases between 17 and 22–23, to then plateau. In fact, a significant difference was reported between underweight (50.8%±36.4%) and normal-weight women (41.4%±37.5%, p < 0.01). A linear regression adjusted for maternal age confirmed this moderate association between increasing BMI and m-ER (unstandardized-coefficient-B –0.6%, 95%CI:–1.1% to –0.1%, p = 0.02). Morphological quality and day of full-blastulation among transferred euploid blastocysts was similar in the three groups. Overweight women showed higher MR per pregnancy (N = 20/75, 26.7%, 95%CI:17.4%–38.3% versus N = 67/461, 14.5%, 95%CI:11.5%–18.2%; OR 2.0, 95%CI:1.1–3.6, p = 0.01) and lower LBR per transfer (N = 55/154, 35.7%, 95%CI:28.3%–43.8% versus N = 388/859, 45.2%, 95%CI:41.8%–48.6%; OR adjusted for euploid blastocysts’ features 0.67, 95%CI:0.46–0.96, p = 0.03). Clinical outcomes were instead similar among underweight and normal-weight women. All gestational and perinatal outcomes were comparable in the tree groups. Limitations, reasons for caution Our study is limited by its retrospective nature, and the fact that maternal BMI was measured only before oocyte retrieval and not before embryo transfer. Moreover, the reduced sample size did not allow for further relevant sub-analyses among solely obese women. Wider implications of the findings: When possible nutritional/lifestyle modifications should be encouraged to adjust maternal BMI before IVF. Overweight patients should be especially informed of their higher risk for miscarriage. Yet, BMI is just a gross marker, future studies based on body fat localization and percentage (e.g. by bioelectrical impedance analyses) are desirable. Trial registration number None

The follicular fluid adipocytokine milieu could serve as a prediction tool for fertility treatment outcomes

Research questionCan the adipocytokine milieu of the follicular niche improve the ability to predict treatment outcomes in infertile patients? DesignFollicular fluid samples from overweight patients were analysed and compared with samples from matched normal-weight patients. Concentrations of adiponectin, chemerin, C-reactive protein, interleukin-6 (IL-6), IL-10, IL-18, insulin, leptin, prolactin, resistin, tumour necrosis factor alpha (TNF-α) and bone morphogenetic protein-15 (BMP-15) were assessed by multiple magnetic bead immunoassay (MMBI) and enzyme-linked immunosorbent assay and correlated with fertility treatment outcomes. ResultsAnalysis of samples from 22 overweight and 22 normal-weight patients demonstrated that TNF-α can predict oocyte maturation rate. When stratified by body mass index (BMI), IL-10 emerges as a better predictor of oocyte maturation in normal-weight patients. Prolactin was a negative predictor for fertilization rate in the full cohort, and this prediction power was lost upon stratification. No adipocytokines were predictive of blastulation rate, and only age remained predictive. BMP-15 was a strong predictor of high-quality blastulation in the full cohort, more so in the normal-weight population. ConclusionsThe adipocytokine milieu of the follicular fluid provides a snapshot of the growing oocyte's environment and can help predict fertility treatment outcomes, fine-tuning understanding of the dysregulation caused by increasing BMI. Inflammatory cytokines can predict oocyte maturation; prolactin, oocyte competence; and BMP-15, high-quality blastulation. Further analysis of these findings with a larger sample size and assessing individual oocytes will help shed more light on the clinical significance of these findings.

A review of effective interventions to improve emotional risk factors of anxiety, stress, depression in infertile and infertile patients undergoing treatment with assisted reproductive techniques

IntroductionInfertility is associated with Several negative reaction and emotional problemsObjectivesReview of effective interventions for improving emotional risk factors In infertile and infertile patients undergoing treatmentMethodsA comprehensive narrative review of the studies was conducted. Databases such as Web of Science, Science Direct, Cochrane Library, Scopus, PubMed, including Medline, Clinical key, SID, MAGIRAN were retrieved from August 10 to December 8, 2020, with no time limit. After reviewing the abstract and the full text of the articles in terms of compliance with the purpose of the study, finally, 32 articles were selected for writing. The methodological quality of the articles was assessed based on Cochrane Risk of BiasResultsInterventions were divided into two subgroups of mind-body, and web-based CBT. mind-body interventions generally shows the anxiety,stress and depression reduction and Possible improvement in pregnancy rate But most of these programs require extensive financial resources The results of web based, showed that using online CBT approach can greatly reduce stress and anxiety, due to increased use of internet, non collaborative,cheap and private treatment of web based interventions, this method can be used as a way along with other treatments to reduce these negative reactionsConclusionsAccording to the present study CBT methods, application and Internet-based interventions can be used as appropriate counseling methods in reducing stress, anxiety and improving pregnancy outcomes in infertile patients. This information can be used as a proper source to select appropriate counseling methods for health care providers, midwives and treatment staff involved in infertility patientsDisclosureNo significant relationships.

Effects of bicornuate uterus on pregnancy and obstetric outcomes of in vitro fertilization / intracytoplasmic sperm injection

ObjectiveA bicornuate uterus results from failure of the Müllerian ducts to completely fuse. If patients with bicornuate uterus are diagnosed with infertility, they can conceive with help from in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). With few studies on the reproductive performances of bicornuate uterus following IVF/ICSI treatment, the aim of present study is to investigate whether a bicornuate uterus would affect pregnancy rates and obstetric outcomes of infertile women. Study DesignA retrospective cohort study contained 232 women (58 with bicornuate uterus and 174 with normal uterus) was conducted. Patient data for IVF/ICSI treatment and follow-up were collected and analyzed. Cumulative pregnancy rate and cumulative live birth rate after one complete assisted reproductive technology (ART) cycle were the primary outcomes. ResultsBaseline characteristics were comparable between the bicornuate uterus group and the control group. Ovarian response to stimulation and embryological results were similar between the two groups. In fresh embryo transfer cycles, embryo implantation rate (32.7 % vs. 42.9 %, P = 0.176), biochemical pregnancy rate (54.1 % vs. 64.9 %, P = 0.236), and clinical pregnancy rate (45.9 % vs. 58.8 %, P = 0.172) did not differ significantly between the bicornuate uterus group and the control group. Live birth rate (40.5 % vs. 43.9 %, P = 0.723), term delivery rate (93.3 % vs. 90.0 %, P = 0.696), cesarean section rate (73.3 % vs. 76.0 %, P = 0.833), and newborn birth weight (3.35 ± 0.56 vs. 3.32 ± 0.51, P = 0.524) also did not differ significantly between the two groups. In frozen-thawed embryo transfer cycles, there were no significant differences in outcomes between the two groups. Upon completion of one IVF/ICSI cycle, cumulative pregnancy rate (59.6 % vs. 71.0 %, P = 0.112) and cumulative live birth rate (58.2 % vs. 64.8 %, P = 0.375) were similar between the two groups. ConclusionThere were no significant differences in ovarian responses, pregnancy outcomes, and obstetric outcomes after IVF/ICSI treatment between women with bicornuate uterus and women with normal uterus. Bicornuate uterus had no significant negative effects on cumulative IVF/ICSI outcomes of infertile patients.

Live birth outcomes in infertile patients with class III and class IV obesity following fresh embryo transfer.

Assess the effect of class III (body mass index [BMI, kg/m2] 40-49.9) and class IV obesity (≥ 50) on clinical pregnancy and live birth outcomes after first oocyte retrieval and fresh embryo transfer cycle. Cohort study SETTING: Academic center PATIENTS: Patients undergoing their first oocyte retrieval with planned fresh embryo transfer in our clinic between 01/01/2012 and 12/31/2018. Patients were stratified by BMI: 18.5-24.9 (n = 4913), 25-29.9 (n = 1566) 30-34.9 (n = 559), 35-39.9 (n = 218), and ≥ 40 (n = 114). None MAIN OUTCOME MEASURE: Live birth rate RESULTS: Following embryo transfer, there were no differences in pregnancy rates across all BMI groups (p value, linear trend = 0.86). However among pregnant patients, as BMI increased, a significant trend of a decreased live birth rate was observed (p value, test for linear trend = 0.004). Additionally, as BMI increased, a significant trend of an increased miscarriage rate was observed (p value, linear trend = < 0.001). Compared to the normal-weight cohort, women with a BMI ≥ 40 had a significantly higher rate of cancelled fresh transfers after retrieval (18.4% vs. 8.2%, OR 2.51; 95%CI 1.55-4.08). Among singleton deliveries, a significant trend of an increased c-section rate was identified as the BMI increased (p value, linear trend = <0.001). Overall, patients with a BMI > 40 have worse IVF treatment outcomes compared to normal-weight patients. After embryo transfer, their pregnancy rate is comparable to normal-weight women; however, their miscarriage rate is higher, leading to a lower live birth rate for pregnant women in this population. Patients with a BMI > 40 have a c-section rate that is 50% higher than normal-weight patients.

Research Progress of Non-coding RNA and Endometrial Receptivity

Endometrial receptivity has become the main cause of in vitro fertilization and pregnancy outcomes in infertile patients,bringing large psychological damage and economic loss to the patients and their family. In recent years,the role of non-coding RNA has increasingly been recognized. The relationship between non-coding RNA and endometrial receptivity is reviewed in this article.

Pregnancy and neonatal outcomes of artificial oocyte activation in patients undergoing frozen-thawed embryo transfer: a 6-year population-based retrospective study.

To evaluate the impact of artificial oocyte activation (AOA) in pregnancy and neonatal outcomes in infertile patients undergoing cryopreserved embryo transfer. This retrospective study included 5686 patients' transferred embryos from routine intracytoplasmic sperm injection (ICSI) and 194 patients' transferred embryos from ICSI combined with AOA (ICSI-AOA) from January 2011 to December 2016. Pregnancy and neonatal outcomes of couples undergoing routine ICSI or ICSI-AOA were analyzed before and after propensity score matching. Artificial oocyte activation was performed with ionomycin. The pregnancy outcomes showed no significant difference in the rates of biochemical pregnancy, clinical pregnancy, implantation, miscarriage, ectopic pregnancy, multiple pregnancy, and live births between the routine ICSI and ICSI-AOA groups before and after propensity score matching, respectively. The assessment of neonatal outcomes showed no statistically significant differences in the birth defect rate, birth weight, gestational age, preterm birth rate, early-neonatal death rate, and fetal sex ratio between the two groups, and similar results were also observed in the two matched cohorts. Artificial oocyte activation with ionomycin does not adversely affect pregnancy and neonatal outcomes in patients undergoing frozen-thawed embryo transfer, which is beneficial to clinicians counseling patients on the risks of artificial oocyte activation.

Maternal chronic hepatitis B virus infection does not affect pregnancy outcomes in infertile patients receiving first in vitro fertilization treatment

To evaluate whether maternal chronic hepatitis B virus (HBV) infection affects pregnancy outcomes in infertile patients undergoing their first invitro fertilization (IVF) treatment. A retrospective case control study. Fertility center. Female patients, comprising 8,550 infertile women including 180 HBsAg+HBeAg+, 714 HBsAg+HBeAg-, and 7,656 HBsAg seronegative controls undergoing their first IVF treatments. Clinical characteristics, pregnancy and neonatal outcomes were analyzed by Kruskal-Wallis test, analysis of variance, or chi-square test. Logistic regression was employed to verify the contribution of maternal HBV to clinical pregnancy, live birth, and miscarriage. Primary outcome: live-birth rate; secondary outcomes: implantation, clinical pregnancy, and miscarriage rates. An increased duration of infertility and more secondary infertility and ovulatory disorders were observed in the HBV patients. The implantation rate was statistically significantly lower in the HBsAg+HBeAg- group compared with the controls. However, the clinical pregnancy rate, miscarriage rate, live-birth rate, neonatal outcomes, and pregnancy complications showed no statistically significant differences among the groups. The logistic regression analysis showed that HBV infection status did not affect the clinical pregnancy, miscarriage, or live-birth rates, unlike maternal age, endometrial thickness, and use of high-quality embryos. Hepatitis B virus infection is not an independent contributor to pregnancy outcomes, although it is associated with prolonged infertility duration, a high frequency of secondary infertility and ovulatory disorders, and a reduced implantation rate.

The impact of hysteroscopic myomectomy on fertility and pregnancy outcomes of infertile women according characteristics of submucous fibroids

Purpose of investigation: To assess fertility and pregnancy outcomes in infertile patients after hysteroscopic myomectomy according characteristics of submucous fibroids. Materials and Methods: The authors included 56 infertile women, who were diagnosed with a submucous uterine fibroid, and assessed their fertility and pregnancy outcomes after hysteroscopic myomectomy, which was the exposure of interest. The control group consisted of 63 women who underwent a hysteroscopic polypectomy. The submucous fibroid and endometrial polyp were diagnosed preoperatively using 2D ultrasound, and the diagnosis was confirmed during hysteroscopy. All myomectomies and polypectomies were performed using a resectoscope with a bipolar loop electrode. In the first postoperative year, the authors analyzed the rates of pregnancy, spontaneous abortion, preterm and term deliveries, as well as mode of delivery according to type, size, location, and number of submucous fibroids or polyps in each group. Results: In the first postoperative year, pregnancy occurred in 30.4% of patients. The greatest proportion of pregnancies occurred after removal of type 1 submucous fibroids, fibroids &lt; 3 cm, and those localized on the posterior wall of the uterine corpus. Spontaneous abortion occurred in 7.1% of pregnancies, while delivery occurred in 19.6%. Term delivery occurred in 16.1%, while preterm delivery occurred in 3.6%. Vaginal delivery occurred in 14.3% of women, while caesarean section was performed in 5.4% of women. There were not significant differences in rates of pregnancy and delivery according to type, size, and localization of the fibroid or endometrial polyp. Conclusion: For infertile patients, in whom infertility is caused by a submucous fibroid, hysteroscopic myomectomy increases the pregnancy rate, and leads to good reproductive outcomes.

Study of Prognostic Factors affecting on the IUI Outcome of Infertile Patients

Objective: The main objective of the study is to determine of prognostic factors on the pregnancy rate after intrauterine insemination (IUI) of infertile patients. Methods: The study was carried out between January 2014 and October 2014 including one hundred and fifty five infertile men who attended the Fertility Center in Al – Sadr Medical City. Results: The of the study showed that there was statistically significant (p 0.01) was showed with type of infertility. Conclusion: Many factors may influence success rate after IUI treatment procedures such as potential sperm parameters, leukocyte concentration, MDA concentration and sperm chromatin maturity as well as age, infertility duration and smoking. Recommendation: Advance study to determine of the effect female factors on the IUI outcome.

The impact of endometrial thickness (EMT) on the day of human chorionic gonadotropin (hCG) administration on pregnancy outcomes: a 5-year retrospective cohort analysis in Malaysia

BackgroundChances of pregnancy in relation to endometrial thickness (EMT) remain elusive albeit some literatures suggest poorer pregnancy outcomes below the threshold of 6-7 mm, notwithstanding others perceive detrimental effect at thicker EMT. We aim to examine the implication of EMT on pregnancy outcomes using a cut-off of 8 mm and further explore for any effect of ‘thick’ EMT in our patient population.MethodsThis was a retrospective cohort study performed for 162 women to assess the associations between EMT on the human chorionic ganadotropin (hCG) trigger day and pregnancy outcomes in infertile patients undergoing in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) and autologous fresh embryo transfer (ET) in controlled ovarian stimulation (COS) cycles under an assisted reproductive technology (ART) shared-care programme between public and private institutions from January 2012 through December 2016.The associations between pregnancy outcomes [Total Pregnancy Rate (TPR), Biochemical Pregnancy Rate (BPR), Clinical Pregnancy Rate (CPR), Ongoing Pregnancy Rate (OPR)/ Live Birth Delivery Rate (LBDR), Miscarriage Rate (MR) and Implantation Rate (IR)] and EMT (< 8 or ≥ 8 mm) on the hCG trigger day were evaluated. Besides, the associations between pregnancies outcomes with EMT ≥ 14 mm and ≥ 8 to < 14 mm were further assessed.ResultsWe found that the ≥8 mm group had a higher TPR (55.4% vs 21.4%; p = 0.015) and CPR (52.0% vs 21.4%; p = 0.029). However, the BPR, MR, OPR/ LBDR and IR were not associated with the EMT (p > 0.05). All pregnancy outcomes were comparable for ≥14 mm and ≥ 8 to < 14 mm subgroups.ConclusionsOur findings suggest that EMT < 8 mm on hCG trigger day could adversely affect TPR and CPR in infertile patients undergoing IVF/ICSI-ET. Besides, we also disprove the notion of reduced chances of pregnancy with EMT ≥ 14 mm. The findings are based on completed cycles which each has demonstrated a triple-line endometrial pattern on the hCG trigger day with fresh autologous ET consisted of high-quality morphological gradings. However, our findings are still preliminary to suggest decision for ET transfer, cycle cancellation or adjunctive therapies. Further studies with larger sample size from this geographical region are required to verify the findings.

Pregnancies outcomes in infertile patients after treatment with ulipristal acetate (UA): preliminary academic art referral center experience

Several large studies have been published on the efficacy of Ulipristal Acetate (UA) prior to myomectomy, but few data are available on the effects of UA in terms of increasing fecundability, implantation, pregnancy outcomes and safety in the general population, and in infertile patients in particular1. Our objective is to estimate the correlation between the use of UA and pregnancy achievement and outcome in infertile patients, conceiving either spontaneously or after ART cycles.

Effect of parental physiological conditions and assisted reproductive technologies on the pregnancy and birth outcomes in infertile patients

Assisted reproductive technologies (ART) are widely used to treat infertility. Emerging evidence suggested that ART was associated with perinatal or neonatal problems, however, little is known about the ART related risk factors. Here using 21136 ART cases, we determined the impacts of parental physiological conditions in the ART mediated pregnancy outcomes. In addition, we further evaluated the effects of three different ART methods (frozen-thawed embryo transfer [FET], in vitro fertilization [IVF] and intracytoplasmic sperm injection [ICSI]) in the pregnancy and birth outcomes in ART mediated pregnancy. Our data revealed that older parental age increases the risks of abortion, preterm birth and low body weight birth. Higher maternal BMI (Body mass index) level correlates with higher abortion rate. Moreover, pregnancy with multiple fetuses has severer adverse outcomes compared to singleton pregnancy. Among the three ART methods, ICSI is associated with lower ratios of ectopic pregnancy, abortion and deformity compared to FET and IVF. Our study revealed new clinical insights into the ART related risk factors and suggested that both the parental physiological conditions and ART methods should be evaluated to develop better ART mediated infertility treatments.

The Place for Prophylactic Cerclage in the Infertile Patient With Established Cervical Incompetence [9D

INTRODUCTION: It is well known that cervical incompetence and associated preterm birth confers greater morbidity and mortality on birth outcomes, with an additional increased risk of cervical incompetence in higher order gestations. While the pathophysiology of cervical incompetence has yet to be elucidated, research has identified risk factors and assessed outcomes of numerous interventions. Cervical cerclage has been shown, in certain situations involving singleton pregnancies, to improve outcomes. Conversely, rescue cerclage increases the risk of preterm birth in twin gestations. However, these studies did not consider the unique situation of infertile patients, with known cervical incompetence, who have utilized assisted reproductive technologies to attain pregnancy. This study aims to describe the outcomes of infertile patients with known cervical incompetence, carrying twin gestation, who have undergone cervical cerclage. METHODS: This case series includes eight infertile patients who have cervical incompetence resulting in fetal loss between 20–24 weeks after in vitro fertilization-embryo transfer (IVF-ET). These patients continued with IVF treatments and subsequently conceived twins. All patients underwent prophylactic cervical cerclage placement before 12 weeks. The outcomes of these pregnancies are reviewed. RESULTS: All pregnancies resulted in the delivery of viable twins. Six of the eight pregnancies (75%) were carried beyond 34 weeks. One pregnancy delivered at 31 weeks and one pregnancy delivered at 25 weeks after placental abruption. CONCLUSION: This data suggest that the use of prophylactic cervical cerclage may be beneficial in improving reproductive outcomes in infertile patients with known cervical incompetence who subsequently conceived twin gestations via IVF-ET treatment.

Malformaciones congénitas en mujeres sometidas a técnicas de reproducción asistida

ObjectiveTo determine the rate of occurrence of birth defects and adverse perinatal outcomes in infertile patients undergoing assisted reproduction techniques. Material and methodWe conducted a retrospective case-control study that included patients undergoing assisted reproduction techniques (IVF, ICSI, CAI, OVODON) in 2013 and a control group of healthy patients who delivered in the same dates. Patients were drawn from the database of the Human Reproduction Unit. Morphological data were obtained from Astraia ultrasound software. The data analysed were collected from the Drago operating system. The statistical analysis was conducted with the SPSS 22.0 statistical package. ResultsThere were 619 patients, of which 38 were excluded due to lack of data. There was a significantly higher percentage of women aged 35-40 years (P<.05) in the cases group. The most frequently used technique was IVF (55.3% of single pregnancies and 16.5% of twin pregnancies). The male factor accounted for 32.9%. A total of 1.2% of controls had a PAPP-A MoM less than 0.3 and all cases showed a PAPP-A greater than 0.3 MoM (P<.05). There were no statistically significant differences between cases and controls in any of the variables studied in relation to defects identified in the morphological ultrasound. The cases group showed more frequent admission to the neonatology ward and neonatal intensive care unit and lower pH values; both these differences were statistically significant (P<.05). ConclusionAnalysis of the different assisted reproduction techniques and their relationship to foetal malformations did not show an increased risk of defects among infants conceived with assisted reproductive techniques compared with newborns resulting from spontaneous conception.

Clinical Outcomes of In Vitro Fertilization among Chinese Infertile Couples Treated for Syphilis Infection.

To compare the clinical outcomes of infertile patients with and without syphilis after in vitro fertilization and embryo transfer (IVF-ET), in this case-control study, 320 infertile couples were enrolled and divided into syphilis (n = 160) and control groups (n = 160). The primary IVF outcomes were the clinical pregnancy rate and the birth of a healthy baby. All syphilis patients received the standard anti-syphilis treatment before undergoing IVF/ICSI. Our results showed that the endometrial thickness of the syphilis group was greater than that of the control group following hCG injection (16.9±5.4 vs. 13.0±4.7 mm, P<0.001). The numbers of normally fertilized eggs and normally cleaved fertilized eggs and the implantation rate were 6.8±4.8, 6.3±4.7 and 24.2%, respectively, for the syphilis group and 8.3±4.6, 8.1±4.6 and 34.4%, respectively, for the control group, and these values were significantly different between the groups. The clinical pregnancy rate was lower in the syphilis group compared with that in the control group (43.8% vs. 55.6%, P = 0.03). Lower offspring birth weight was observed in the infected male group compared with those in the infected female (2.7±0.4 vs. 3.0±0.4 kg, P = 0.01) and infected couple groups (2.7±0.4 vs. 3.1±0.5 kg, P = 0.007). Therefore, syphilis infection reduces the clinical pregnancy rate after IVF/ICSI.

Introduction: Role of mental health professionals in the care of infertile patients

The authors of this Views and Reviews describe the evolution of the role of mental health counseling in infertility care. As the use of assisted reproductive technologies and third-party reproduction has grown, so too has the interest and demand for mental health services. A historical perspective is presented that sets the stage for subsequent discussions of key areas where mental health practitioners are able to contribute to the utility and outcomes of infertile patients as well as those involved in their care. This series of articles stresses the value of more comprehensive integration of mental health support into infertility practice and highlights practical opportunities to do so.

Improvement in in vitro fertilization outcome following in vivo synchronization of oocyte maturation in mice.

Synchronization of oocyte maturation in vitro has been shown to produce higher in vitro fertilization (IVF) rates than those observed in oocytes matured in vitro without synchronization. However, the increased IVF rates never exceeded those observed in oocytes matured in vivo without synchronization. This study was therefore designed to define the effect of in vivo synchronization of oocyte maturation on IVF rates. Mice were superovulated and orally treated with 7.5 mg cilostazol (CLZ), a phosphodiesterase 3A (PDE3A) inhibitor, to induce ovulation of immature oocytes at different stages depending on frequency and time of administration of CLZ. Mice treated with CLZ ovulated germinal vesicle (GV) or metaphase I (MI) oocytes that underwent maturation in vitro or in vivo (i.e. in the oviduct) followed by IVF. Superovulated control mice ovulated mature oocytes that underwent IVF directly upon collection. Ovulated MI oocytes matured in vitro or in vivo had similar maturation rates but significantly higher IVF rates, 2-4 cell embryos, than those observed in control oocytes. Ovulated GV oocytes matured in vitro showed similar maturation rates but significantly higher IVF rates than those observed in control oocytes. However, ovulated GV oocytes matured in vivo had significantly lower IVF rates than those noted in control oocytes. It is concluded that CLZ is able to synchronize oocyte maturation and improve IVF rates in superovulated mice. CLZ may be capable of showing similar effects in humans, especially since temporal arrest of human oocyte maturation with other PDE3A inhibitors in vitro was found to improve oocyte competence level. The capability of a clinically approved PDE3A inhibitor to improve oocyte fertilization rates in mice at doses extrapolated from human therapeutic doses suggests the potential scenario of the inclusion of CLZ in superovulation programs. This may improve IVF outcomes in infertile patients.

Revised Super-long Down-regulation Protocol Improves the Outcome of Infertile Patients with Repeated Implantation Failure in IVF/ICSI-ET

Objective To investigate the outcome of revised super-long down-regulation protocol (RSDP) for in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) in the special infertile patients with repeated implantation failure (RIF). Methods Patients with RIF were divided into RSDP group and routine long down-regulation protocol (RLDP) group. In RSDP group, gonadotropin releasing hormone agonist (GnRHa) was injected intramuscularly by 2.5 mg in mid-luteal phase for the first time and 1.25 mg after 28 d; gonadotropin (Gn) was started 14 d later after the second GnRHa dose. IVF/ICSI-ET was performed according to the routine procedure. The clinical outcomes of RSDP group were compared with those of RLDP group. Results In RSDP group, the number of retrieved oocytes and valid embryos was significantly lower (P 0.05); both good-quality embryo rate and implantation rate were significantly increased (P Conclusion RSDP can improve the IVF outcomes significantly in RIF patients.